Using Ultrasonography to Assess the Effectiveness of Cricoid Pressure on Esophageal Compression

Kei, Jonathan; Utschig, E.E.; Tonder, R.J. Van

doi:10.1016/j.jemermed.2017.04.025

Cited by 10 publications

(6 citation statements)

References 7 publications

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“…The benefits, and indeed the efficacy of rapid sequence induction have been previously questioned, scrutinised and debated . Several studies have specifically assessed the efficacy of this manoeuvre to occlude the oesophageal entrance .…”

Section: Discussionmentioning

confidence: 99%

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

et al. 2018

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Cricoid pressure is employed during rapid sequence induction to reduce the risk of pulmonary aspiration. Correct application of cricoid pressure depends on knowledge of neck anatomy and precise identification of surface landmarks. Inaccurate localisation of the cricoid cartilage during rapid sequence induction risks incomplete oesophageal occlusion, with potential for pulmonary aspiration of gastric contents. It may also compromise the laryngeal view for the anaesthetist. Accurate localisation of the cricoid cartilage therefore has relevance for the safe conduct of rapid sequence induction. We conducted a multicentre, prospective cohort study to determine the accuracy of cricoid cartilage identification in 100 patients. The cranio-caudal midpoint of the cricoid cartilage was identified by a qualified anaesthetic assistant using the conventional landmark technique and marked. While maintaining the patient in the same position, a second mark was made by identifying the midpoint of the cricoid cartilage using ultrasound scanning. The mean (SD) distance between the two marks was 2.07 (8.49) mm. In 41% of patients the midpoint was incorrectly identified by a margin greater than 5 mm. This error was uniformly distributed both above and below the midpoint of the cricoid cartilage. The Pearson correlation coefficient of this error with respect to body mass index was 0.062 (p = 0.539) and with age was -0.020 (p = 0.843). There were also no significant differences in error between male and female patients. Identification of cricoid position using a landmark technique has a high degree of variability and has little correlation with age, sex or body mass index. These findings have significant implications for the safe application of cricoid pressure in the context of rapid sequence induction.

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Section: Discussionmentioning

confidence: 99%

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

et al. 2018

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“…We do not know the exact position of the catheter in the lumen, therefore it is unknown whether the detected pressures are representative of parts of the esophagus not in contact with the catheter. Previous studies have also shown that the esophagus is lateralized during cricoid pressure, making the occlusion less likely, although the presence of a high‐pressure zone covering the lateralized esophagus makes this objection less relevant. Additionally, some parts of the proximal limit of the high pressure zone during cricoid pressure are missing in the analysis for some subjects, since an analysis of the UES was not the primary aim of the original study.…”

Section: Discussionmentioning

confidence: 99%

Pressure measurement in the upper esophagus during cricoid pressure: A high‐resolution solid‐state manometry study

Pellrud

Ahlstrand

2018

Acta Anaesthesiol Scand

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This study using high-resolution solid-state manometry under clinically relevant conditions shows that 30 N cricoid pressure generates high pressure in the area of the UES, far exceeding the levels previously considered necessary to prevent regurgitation. Additional studies are needed to clarify the effectiveness of cricoid pressure in preventing passive regurgitation before it is rejected as a part of rapid sequence induction.

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“…Classically, cricoid pressure has been used to prevent gastric regurgitation in unresponsive patients with an unsecured airway, yet in recent years the benefit of cricoid pressure has been called into question [[9], [10], [11], [12], [13]]. In 2017, Kei et al showed that cricoid pressure could not prevent liquid from entering the esophagus [3]. In addition to having questionable efficacy, cricoid pressure is also associated with certain negative outcomes, such as cricoid cartilage fracture [11], airway obstruction [12], or an impaired laryngeal view during intubation [13].…”

Section: Discussionmentioning

confidence: 99%

“…More recently, attention has been drawn to the use of ultrasound in airway assessment and management. For example, Kei et al utilized POCUS to visualize the passage of carbonated beverages in the esophagus of healthy volunteers both during and without cricoid pressure, showing that cricoid pressure did not prevent passage of liquid [3]. Additionally, Bouvet et al demonstrated that POCUS can identify air in the stomach during facemask ventilation of anesthetized patients in an operating room [4].…”

Section: Introductionmentioning

confidence: 99%

Use of point-of-care ultrasound to assess esophageal insufflation during bag mask ventilation: A case report

Baskin

Kimura

2019

Respiratory Medicine Case Reports

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Bag-valve-mask ventilation is a basic airway management technique often used in patients with acute respiratory failure. Although highly effective in providing oxygenation and ventilation, this technique has been associated with gastric regurgitation and tracheal aspiration. In this case, the esophagus was visualized with bedside ultrasonography during bag-mask ventilation of an unresponsive and critically ill patient. Images were obtained both with and without cricoid pressure. Additionally, images were obtained during ultrasound-guided probe pressure on the lateral neck. Esophageal insufflation was identified consistently during bag mask ventilation. Cricoid pressure did not prevent esophageal insufflation. Ultrasound-guided probe pressure attenuated esophageal insufflation. This case depicts a unique instance of using a novel method to assess breath delivery during bag mask ventilation of a critically ill patient.

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Using Ultrasonography to Assess the Effectiveness of Cricoid Pressure on Esophageal Compression

Cited by 10 publications

References 7 publications

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

A multicentre prospective cohort study of the accuracy of conventional landmark technique for cricoid localisation using ultrasound scanning

Pressure measurement in the upper esophagus during cricoid pressure: A high‐resolution solid‐state manometry study

Use of point-of-care ultrasound to assess esophageal insufflation during bag mask ventilation: A case report

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